{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T01:04:32Z","timestamp":1768352672119,"version":"3.49.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2021,1,24]],"date-time":"2021-01-24T00:00:00Z","timestamp":1611446400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,24]],"date-time":"2021-01-24T00:00:00Z","timestamp":1611446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Projekt DEAL"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Strahlenther Onkol"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Metastatic non-small cell lung cancer (NSCLC) often requires a\u00a0multimodal treatment including chemotherapy, targeted therapy and radiotherapy. In addition to this, many patients take supportive drugs. Since only scarce data on possible interactions between radiotherapy and pharmaceutical or herbal drugs exist, description of clinical cases is of special interest.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case report<\/jats:title>\n                <jats:p>A\u00a0patient with stage IV\u00a0NSCLC was treated with docetaxel\/ramucirumab followed by radiotherapy for brain and bone metastases while taking several other over-the-counter drugs (OTCs) including topical St. John\u2019s wort skin oil.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A\u00a063-year-old female patient with stage IV\u00a0NSCLC presented with 11\u00a0asymptomatic brain metastases and a\u00a0painful osteolytic bone metastasis in the 12th\u00a0thoracic vertebral body (T12). Four weeks before the start of palliative whole-brain radiotherapy and bone irradiation of T12, she was administered a\u00a0combination of docetaxel and ramucirumab. At an administered dose of 24\u202fGy, the patient presented with severe folliculitis capitis, while skin examination over the thoracolumbar spine was unremarkable although skin dose was similar. After thorough questioning, the patient reported using a\u00a0herbal skin oil that contained St. John\u2019s wort for scalp care only, but not for skin care of her back during radiotherapy. After stopping the topical application of the skin oil, folliculitis improved with a\u00a0course of systemic and topical antibiotics within 10\u00a0days, though the healing process was prolonged and included desquamation and hyperpigmentation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>St. John\u2019s wort seems to be a\u00a0significant radiosensitizer for photon radiotherapy and can cause severe skin toxicity even though the literature lacks data on this interaction. As an OTC, it is easily accessible and often used by oncological patients due to antidepressant and local antimicrobial and pain-relieving effects.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00066-020-01739-0","type":"journal-article","created":{"date-parts":[[2021,1,24]],"date-time":"2021-01-24T22:02:35Z","timestamp":1611525755000},"page":"644-649","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Severe skin toxicity during whole-brain radiotherapy, targeted therapy, and additional drug intake including St. John\u2019s wort skin oil"],"prefix":"10.1007","volume":"197","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0150-1328","authenticated-orcid":false,"given":"Tanja","family":"Eichkorn","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Schunn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Regnery","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rami El","family":"Shafie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliane","family":"H\u00f6rner-Rieber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Adeberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Herfarth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Debus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laila","family":"K\u00f6nig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,1,24]]},"reference":[{"issue":"1","key":"1739_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.2174\/0929867324666161118125103","volume":"24","author":"P Maione","year":"2017","unstructured":"Maione\u00a0P, Sgambato\u00a0A, Casaluce\u00a0F, Sacco\u00a0PC, Santabarbara\u00a0G, Rossi\u00a0A et\u00a0al (2017) The role of the antiangiogenetic ramucirumab in the treatment of advanced non small cell lung cancer. 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Written informed consent was given by the patient for participating in this investigation. Patient confidentiality was maintained by anonymizing patient data to remove any identifying information. The patient provided written informed consent for publication of data and images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}